Development of the coping with burns questionnaire

Depression, postburn disability & quality of life: The moderating roles of burn specific coping strategies

Depression has been associated with poorer postburn functional outcomes. However, whether or not certain burn specific coping strategies moderate the relationships remains unknown. Burn survivors from 2015 Formosa Fun Coast Water Park explosion were recruited in a 3-year follow-up study. Using Wave 1 data collected 1 year after discharge, we conducted multivariate regression analysis to assess the associations between depression and postburn disability and quality of life. We also performed moderation analysis to determine moderating effects of burn specific coping strategies on the associations. Our results found depression was significantly associated with worsening postburn disability and poorer quality of life. When demographic and burn related variables were accounted for, we found avoidance coping moderated the depression-disability relationship. Depression was significantly and positively correlated with disability at low and medium levels of avoidance but not high. Optimism/problem solving moderated the depression-quality of life relationship. Depression was significantly and negatively correlated with quality of life at low and medium levels of optimism/problem solving but not high. Our study provided evidence supporting early identification and intervention of depression in burn survivors to optimize functional outcomes. Such knowledge may provide insights into potential targets in rehabilitation in depressed burn survivors.

Handling traumatic experiences in facially disfigured female burn survivors

BACKGROUND

This research deals with the impact of resilience, perceived stigmatization, social comfort and coping strategies on quality of life among female burn survivors with facial disfigurement, man many of which are found in Asian countries.

METHODS

Using cross-sectional research design, female burn survivors with severe facial disfigurement (N = 100) were drawn by using purposive sampling strategy from a public sector hospital and an organization working in Lahore, Pakistan. Perceived Stigmatization Questionnaire (PSQ) (Lawrence et al., 2006), Social Comfort Questionnaire (SCQ) (Lawrence et al., 2006), State-Trait Resilience Scale, Coping with Burns Questionnaire (CBQ) (Willebrand et al., 2001) and World Health Organization Quality of Life Brief Questionnaire (WHOQOL-BREF Questionnaire; World Health Organization, 2014) were used for assessment.

RESULTS

The analyses showed a significant positive relationship among resilience, coping with burns and social comfort. A significant negative relationship was found between perceived stigmatization and coping with burns, resilience and social comfort. All these variables were tested for differentiation on the basis of survivor's age (less vs. more than 30 years), occupation (housewife vs. gainfully employed), education (less vs. more than matriculation), social status (low vs. middle class), family system (nuclear vs. joint), siblings (yes vs. no), residence (living in home vs. shelter home) and psychological help received or not after the burn injury. Results indicate a mixed type of phenomenon among variable's differentiation. Path analysis through AMOS resulted into a model showing no direct relationship of quality of life with coping with burns, perceived stigmatization and resilience; however, social comfort mediates the relationship between quality of life and coping with burns, perceived stigmatization and resilience.

CONCLUSION

It is found that quality of life is dependent on coping with burns, perceived stigmatization and resilience through social comfort. The findings hold implications for the mental health professionals and rehabilitation service providers to emphasize on the restorative strategy for burn survivors to elevate their social comfort, to assist them in handling their injuries and develop a curative plan to support them in their coping skills.

Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients

The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.

Development of a Conceptual Framework to Measure the Social Impact of Burns

Measuring community reintegration following burn injury is important to assess the efficacy of therapies designed to optimize recovery. This project aims to develop and validate a conceptual framework for understanding the social impact of burn injuries in adults. The framework is critical for developing the item banks used for a computerized adaptive test. We performed a comprehensive literature review and consulted with clinical experts and burn survivors about social life areas impacted by burn injury. Focus groups with burn survivors and clinicians were conducted to inform and validate the framework. Transcripts were coded using grounded theory methodology. The World Health Organization's International Classification of Functioning, Disability and Health, was chosen to ground the content model. The primary construct identified was social participation, which contains two concepts: societal role and personal relationships. The subdomains chosen for item development were work, recreation and leisure, relating with strangers, and romantic, sexual, family, and informal relationships. Qualitative results strongly suggest that the conceptual model fits the constructs for societal role and personal relationships with the respective subdomains. This conceptual framework has guided the implementation of a large-scale calibration study currently underway which will lead to a computerized adaptive test for monitoring the social impacts of burn injuries during recovery.

Measuring the Social Impact of Burns on Survivors

Many burn survivors experience social challenges throughout their recovery. Measuring the social impact of a burn injury is important to identify opportunities for interventions. The aim of this study is to develop a pool of items addressing the social impact of burn injuries in adults to create a self-reported computerized adaptive test based on item response theory. The authors conducted a comprehensive literature review to identify preexisting items in other self-reported measures and used data from focus groups to create new items. The authors classified items using a guiding conceptual framework on social participation. The authors conducted cognitive interviews with burn survivors to assess clarity and interpretation of each item. The authors evaluated an initial pool of 276 items with burn survivors and reduced this to 192 items after cognitive evaluation by experts and burn survivors. The items represent seven domains from the guiding conceptual model: work, recreation and leisure, relating to strangers, romantic, sexual, family, and informal relationships. Additional item content that crossed domains included using self-comfort and others' comfort with clothing, telling one's story, and sense of purpose. This study was designed to develop a large item pool based on a strong conceptual framework using grounded theory analysis with focus groups of burn survivors and their caregivers. The 192 items represent 7 domains and reflect the unique experience of burn survivors within these important areas of social participation. This work will lead to developing the Life Impact Burn Recovery Evaluation profile, a self-reported outcome measure.

Fear-avoidance in Recovered Burn Patients: Association with Psychological and Somatic Symptoms

Fear-avoidance, an important model in the understanding of chronic pain, has not yet been studied in patients with burns. The purpose of this study was to investigate if recovered burn patients have fear-avoidance beliefs and to explore the association with psychological and somatic symptoms. Eighty-four recovered burn patients completed self-report questionnaires. The results showed that there were fear-avoidance beliefs, but not to a large extent. Beta coefficients from multiple regression analyses indicated a strong association between fear-avoidance and problems with work, heat sensitivity and arousal symptoms. The model was capable of explaining 73 per cent of the variance in fear-avoidance beliefs.

Making meaning in a burn peer support group: qualitative analysis of attendee interviews

There is a paucity of literature on the personal experiences of burn support group members, the members' perceived benefits of group participation, and the meaning the survivors make of the support they receive. In order to provide effective psychosocial rehabilitation services and to meet the needs of burn survivors, it is important to understand the influence a support group has on its members as well as the personal experiences of those individuals who attend these groups. The purpose of this study was to explore the experiences of burn survivors in a burn survivor support group. Six self-identified burn survivors were interviewed by using a guided in-depth interview technique to explore their experiences in the support group. Key informant interviews and group observations served to triangulate the findings from the individual interviews. The experiences of the group members coalesced around four main themes: acceptance of self, perspective change, value of community, and reciprocity. The findings demonstrated the overall perceived positive impact the support group had on psychosocial recovery. For these members, the group aided the process of adjustment through the encouragement of adaptive coping strategies and the facilitation of community and relationships. Their experiences mirrored much of the literature on psychological growth from adversity. Burn survivors reported unique opportunities that allowed them to integrate their injury into their identity within an encouraging and safe environment. Using these accounts, the authors generated clinical suggestions that may encourage similar growth in other support group settings.

Influencing factors of the quality of life in Chinese burn patients: Investigation with adapted Chinese version of the BSHS-B

OBJECTIVE

The study aims to evaluate the quality of life (QOL) in burn patients in China and find out principal influencing factors, so as to provide evidence for interventions.

METHODS

A total of 271 burn patients in three major burn units in China were asked to fill in the adapted Chinese version (ACV) of the Burn Specific Health Scale-Brief (ACV BSHS-B) in order to seek out the principal influencing factors in combination with a self-designed demographic and disease condition questionnaire. Multivariable linear regression was used to analyse the principal influencing factors.

RESULTS

The findings showed that there were seven principal influencing factors for the overall ACV BSHS-B score. They were: percent total body surface area (TBSA) burned (with the standardised regression coefficient being -0.594), burn area of lower limber (0.241), itch level (-0.227), pain level (-0.220), gender (0.217), mechanical ventilation (0.216) and hand deformity (-0.141).

CONCLUSION

QOL decreased in burn patients to different degrees depending on the intensity of burns. With a better understanding of influencing factors of burn patients' QOL, the medical and nursing staff can take specific countermeasures to help patients gain a higher QOL.

Psychiatric morbidity predicts perceived burn-specific health 1 year after a burn

OBJECTIVE

Individual factors such as gender, age, coping and personality traits and injury-related factors such as injury severity have been implicated as risk factors for poor perceived health after burns. As psychiatric morbidity is common in individuals who sustain burns, the aim of this study was to examine the effect of preinjury psychiatric problems on perceived health after injury.

METHOD

A total of 85 consecutive patients treated at a national burn center were prospectively assessed: the patients were interviewed during acute care with the Structured Clinical Interview for DSM-IV Axis I Disorders. One year after injury, perceived health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B). Multiple regression analyses were used to evaluate the predictive effect of preinjury psychiatric history on perceived postinjury health.

RESULTS

Psychiatric morbidity, especially mood disorders, affected outcome for six of the nine BSHS-B subscales, with the covariates mainly being the length of hospital stay and total burn size.

CONCLUSION

The results show that a history of preinjury psychiatric disorders, especially during the year before the burn, affects perceived outcome regarding both physical and psychological aspects of health 1 year after injury and that it is a risk factor for worse perceived outcome.

Gender differences in the quality of life and coping patterns after discharge in patients recovering from burns in China

The purpose of this study was to investigate gender differences in quality of life and coping patterns after discharge for patients with burns in China. Cross-sectional survey research design and purposive sampling were used in this study, for which 92 subjects, including 56 males and 36 females, were recruited from a medical centre in central China. Quality of life was measured by the burn-specific health scale-brief (BSHS-B) and coping patterns were measured with the coping with burns questionnaire (CBQ), while demographic data was collected using a demographic questionnaire. An independent t-test and bivariate correlate were employed to analyse the data. The study results showed significant differences in quality of life between genders and coping patterns. There was a statistically significant gender difference in the sub-domain of the BSHS-B score for affect and relations, p < 0.05, and for coping patterns: emotion support, p < 0.05. The findings indicated that optimism/problem solving, revolution/adjustment and avoidance were the most commonly used coping patterns for males and females. The rank orders were same. The study indicated that women are more sensitive to relationships with family after discharge and tend to exhibit depressive symptoms. For women, emotional support is more important than it is for men. A number of significant positive and negative correlations were found among the variables.

Positive change after severe burn injuries

Aims of the study were to examine positive change in people with severe burn injuries and to examine the impact of related constructs, demographic and medical variables on Post Traumatic Growth (PTG). A total of 149 participants who had been treated for a severe burn injury completed the posttraumatic growth inventory as well as other self-report inventories assessing coping, social support, quality of life, and mental distress. Similar to other populations who experienced trauma and adversity, burn survivors also report PTG. The strongest predictors for PTG were active coping and social support. Gender and age differences were found in the current study. Implications for further research and interventions facilitating PTG are discussed.

Emotional Distress and Psychosocial Resources in Patients Recovering From Severe Burn Injury

Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. However, patients also reported high levels of resources such as general optimism, self-efficacy, and perceived social support. Within the sample, no significant correlation between severity of emotional distress and severity of burn injury was found. By psychological assessments a subgroup of highly distressed patients was identified. These patients were highly emotionally distressed while having objective injury severity comparable with the other patients in the sample. Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.

Social desirability, psychological symptoms, and perceived health in burn injured patients

Social desirability was previously seen as a nuisance in assessment, but today it is regarded as a personality trait with an influence on health. The aim was to explore relations between social desirability and health in former burn patients. Eighty-four burn patients injured on average 3.8 years ago responded to a questionnaire booklet. Social desirability was assessed with the social desirability subscale of the Swedish universities Scales of Personality, which is standardized in a normative sample. The results showed that a subgroup with high degree of social desirability displayed significantly poorer perceived health on the burn-specific health subscales heat sensitivity, work, and body image than normal responders did. There were no differences regarding age, education, injury-related variables, sick leave, or symptoms of anxiety and depression. In conclusion, participants with high social desirability were characterized by postburn problems in outdoor and work-related situations, and more self-consciousness about appearance.

Coping strategies, injury characteristics and long-term outcome after burn injury

Coping consists of cognitive and behavioural strategies aimed at enhancing adaptation, and the use of certain coping strategies is proposed to be beneficial for health. The relationship between coping strategies and burn injury characteristics, sociodemographics and long-term outcome was evaluated in 161 previous victims of severe burn injury. Functional and psychosocial restrictions were measured with the burn specific health scale-brief (BSHS-B) and related to coping strategies measured by the coping with burns questionnaire (CBQ). Patients were on average 47.7 years at measurement of health status and they were assessed 9.2 (S.D. = 4.8) years after injury. The mean area burned was 24.0 and 7.2% was full thickness injury. There was no relation between coping strategies and injury characteristics except in individuals with a full thickness burn exceeding 10%, who exhibited more Revaluation/adjustment. An Avoidant coping strategy was related to work status, marital status and living conditions, and this was the strategy most clearly related to "Bad outcome" in all scales of the BSHS-B. Emotional support was the most beneficial strategy and was mainly associated with the psychosocial scales of the BSHS-B.

Prediction of Psychological Health After an Accidental Burn

BACKGROUND

Burn victims often display psychological symptoms that can impede recovery, but knowledge about risk factors for psychopathology is limited. This study aimed to predict psychological health 3 months after burn injury from coping and trauma-related factors assessed early in hospitalization.

METHODS

For this study, 34 burn patients were interviewed during hospitalization about their accident and coping. Questionnaires were administered during hospitalization and 3 months after the burn including the Impact of Event Scale-Revised for posttraumatic stress symptoms (intrusion, avoidance, arousal) and the Hospital Anxiety and Depression Scale for mood.

RESULTS

Anxiety, depressive, and avoidant symptoms at 3 months were highly predicted by baseline levels of these symptoms and avoidant coping. The life threat at the burn event predicted intrusive and arousal symptoms, and coping by self-control predicted less intrusive symptoms. Burn severity was not predictive of psychological health.

CONCLUSIONS

Coping style, life threat during the accident, and early symptoms are strong predictors of psychopathology after a burn.

Personality Characteristics and Perceived Health Problems After Burn Injury

The relationship between personality traits and the perceived outcome of burn injury 1 to 18 years (mean, 9.2 years) after severe burn injury was evaluated in 166 individuals treated at the Uppsala Burn Unit. The perceived outcome was measured with the Burn Specific Health Scale-Brief (BSHS-B) and was related to personality traits evaluated by means of the Swedish universities Scales of Personality. After controlling for age at inquiry, time since injury, burn area, and sex, a stepwise logistic regression analysis revealed an association between the Swedish universities Scales of Personality domain Neuroticism and Bad outcome in all BSHS-B domains, both psychosocial and physical, and Insufficient outcome in the domains Work, Body image, Affect, and BSHS-B total score. The neurotic traits Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Embitterment, and Mistrust each or in different combinations explained the observed relationships. The data suggest that personality is related to health status because it is perceived a long time after severe burn injury and that its effect is not confined only to psychological but also to physical aspects of life.

Psychopathology and psychological problems in patients with burn scars: epidemiology and management

Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.

Chronic Nightmares After Severe Burns: Risk Factors and Implications for Treatment

Although patients frequently experience sleep disturbances and nightmares in the first weeks after a severe burn, information is scarce on the course and prevention of this problem. Prolonged experience of nightmares in adults is one of the symptoms of posttraumatic stress disorder. The aim of this work was to determine risk factors for developing chronic nightmares after severe burns. Personality traits and coping strategies were assessed. As part of a follow-up study of patients treated at the Burn Center at Uppsala University Hospital, Uppsala, Sweden, between 1980 and 1995, the questionnaires of 166 patients (34 females, 132 males, average age 50 years, average burn size 25% TBSA, full-thickness burn size 10% TBSA, average time since burn 11.4 years) were analyzed. The effects of individual personality traits and coping strategies on the frequency of nightmares were evaluated by regression analysis. Nightmares were reported by 43% of the patients, by females more frequently than males. The frequency of nightmares was shown to be associated with the size of the full-thickness burn. The use of Avoidance or Revaluation/Adjustment scales as coping strategies and the presence of Somatic Trait Anxiety as a personality trait were associated with a higher frequency of nightmares after correction for gender. In contrast, persons seeking Emotional Support as a coping strategy reported significantly fewer nightmares. Certain personality traits and coping strategies apparently increase the risk of having nightmares after a severe burn. Helping persons at risk develop different coping strategies may be a possible means of prevention or treatment.

What is coping? A critical review of the construct and its application in audiology

The term 'coping' is increasingly used in audiology, in particular by researchers and clinicians interested in the psychosocial aspects of hearing disorders. Coping has been defined as the process of managing demands (external or internal) that are appraised as taxing or exceeding the resources of the person. It is seen as a process involving at least two stages: primary appraisal (is this something to bother about?), and secondary appraisal (what can I do about it?). It is proposed to serve two distinct purposes: to do away with the problem (i.e. problem-focused coping), and to regulate emotional reactions (emotion-focused coping). The following observations are made: (1) there is a lack of correspondence between what people in general mean by coping and how the concept is used in research; (2) coping is most often measured by checklists with questionable validity; (3) the outcome of using different coping strategies is largely unexplored; and (4) what is regarded as coping in some circumstances (e.g. telling about your hearing impairment) can become a problem in another situation, or even the same situation (e.g. stigma). Finally, some recommendations regarding the future use of the coping construct in audiology are made.

Exploration of coping patterns in burned adults: cluster analysis of the coping with burns questionnaire (CBQ)

The aim of this study was to investigate coping patterns, health status and personality traits in burned adults. Subjects were 161 burn patients treated at the Uppsala University Hospital between 1980 and 1995. Measures were the coping with burns questionnaire (CBQ), the burn specific health scale-brief (BSHS-B) and the Swedish universities scales of personality (SSP). The CBQ was subjected to a K-means cluster analysis and three clusters were derived: extensive, adaptive, and avoidant copers. Extensive copers used the most coping and took an intermediate role regarding health status and the personality trait of neuroticism. Adaptive copers preferred the strategies emotional support and optimism/problem solving, and had the highest health status ratings. Avoidant copers preferred the strategy avoidance and reported the lowest use of emotional support and optimism/problem solving. They had the lowest health status ratings and the highest ratings on neuroticism and aggressiveness. The clusters did not differ in severity of injury or time since injury. In conclusion, coping patterns can be discerned among burn patients, and those individuals preferring avoidance and lacking other coping options displayed more maladaptive traits and poorer health status years after the burn.

Cognitive distortions in recovered burn patients: the emotional Stroop task and autobiographical memory test

The aim of the study was to explore cognitive distortions in recovered burn patients. Previous studies in trauma patients have shown trauma-specific attentional bias, long response latencies, and deficits in memory specificity. Eighteen former patients, burn injured 5-19 years ago and 18 matched controls performed the emotional Stroop task, including burn and general trauma-related words, and the autobiographical memory test (AMT). In addition, verbal fluency, life events, and current mood were assessed. Regarding the Stroop task, the recovered patients had longer response latencies to burn words than to neutral and trauma words, a difference not seen in the control subjects. Regarding the AMT, the memory specificity did not differ between the groups. Overall, the former patients had longer latencies than the controls and poorer verbal fluency. The present study showed that recovered burn patients display a moderate Stroop effect, i.e. an attentional bias, in spite of the fact that the injury occurred several years before the testing. This may imply that the recovered burn patients consider the burn an important issue in life. The post-burn patients also presented signs of a slight cognitive slowness as compared to the controls. This finding deserves further attention in the rehabilitation of burn patients.